Provider Demographics
NPI:1407172737
Name:PT COACH, LLC
Entity Type:Organization
Organization Name:PT COACH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:JURASKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-695-5083
Mailing Address - Street 1:8426 E SHEA BLVD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6634
Mailing Address - Country:US
Mailing Address - Phone:203-695-5083
Mailing Address - Fax:
Practice Address - Street 1:10869 N SCOTTSDALE RD
Practice Address - Street 2:# 103-197
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5280
Practice Address - Country:US
Practice Address - Phone:480-264-0692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty